12th Biennial National Conference Choices that matter: ECI in a new era … Are we ASD ready? Assessing the readiness of mainstream early childhood education and care centres to provide ASD early intervention Dr Damhnat McCann, Kathryn Fordyce, Dr Lyndsay Quarmby, Dr Merylin Cross, Colleen Cheek, Miranda Stephens, Dr Ceridwen Owen, Dr Penny Allen 7-9 September, 2016 Melbourne, Australia

NW Tasmania NW Tasmania ranges from ASGC remoteness classifications ‘inner regional’, to ‘very remote’ Population of nine NW Tas municipalities 109,151 (ABS, 2011) High socio-economic disadvantage - overall RSD decile rating of 3 (Devonport, Burnie & West Coast only 2) 24.6% year 12 completion (those 15 years & older). Education levels lower than the average for non-major urban areas in Australia (Walker & Fairbrother, 2015) Unemployment levels above national average Tasmania has highest prevalence of childhood disability in Aust. Second highest prevalence rates of ASD (2012 data) (ABS, 2014) ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

BUT - Tasmania ranked fourth-best region in the world by Lonely Planet 2015

Funded by Australian Government Department of Social Services NW Tasmania ASELCC Funded by Australian Government Department of Social Services Children have improved capacity to participate in child care, early learning and education settings, transition and interact with other children. Parents/carers have improved capacity to participate in the community and manage the needs of their children with ASD. The ASD Sector has improved capacity to develop strategies to improve access, collaborate to facilitate research and develop best practice, and build workforce capacity. One of six ASELCC nationally Only in regional area Service is due to transition to the NDIS in 2018 ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

Autism Early Intervention in “Childcare” National Quality Framework (ACECQA, 2012) Autism Good Practice Guidelines (Prior & Roberts, 2012) ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

NW Tasmania ASELCC Team Child Key Worker Speech Pathologist Occupational Therapist Early Childhood Teacher Psychologist Social Worker Early Childhood Educators Family Close relationships with: DoE ECIS Local health services Autism Tasmania State-wide Autism Assessment Service Local Schools Child and Family Centres Education and Care Services

What we know already – child outcomes Retrospective analysis of clinical data (n=98) Improvements in a number of the assessed measures Vineland Adaptive Behaviour Scale – II - Receptive Language, Community Daily Living, Interpersonal Relationships, Communication Domain; Autism Symptoms measured by SCQ; Mullen Scales of Early Learning - Visual Reception, Receptive Language, Expressive Language Similar outcomes in hub and spokes Hub and spokes promising method of supporting mainstream childcare centres to implement EI - extends the reach of specialists and responsive to community needs Stephens, Allen, Fordyce, Minchin & Cheek (2016): Early intervention for children with autism: An Australian rural hub and spokes model, Research and Practice in Intellectual and Developmental Disabilities

What we know already – Parent Outcomes Study 1: Tas & SA ASELCC mixed method study investigating QoL, social inclusion and perception of the centres Parents had low quality of life but reported a number of benefits from receiving services including increased levels of community participation and increased self- reported confidence and competence as parents. Study 2: Retrospective analysis of DASS and PSOC Data for parents with 2 time points (n=76) and qualitative interview (n=13, 6 male; 7 female) No significant differences on formal assessments of mental health and parental competence between time points. However, parents reported improvements in acceptance, reassurance, parenting skills and confidence, a sense of community, self- worth, and hope for the future. Study 1: Due, Allen, Button, Cheek, Ferguson, Goodwin-Smith, Quarmby, Stephens, Vroulis & Fordyce (in press), A Pilot Study of social inclusion and quality of life for parents of children with Autism Spectrum Disorder, Journal of Intellectual and Developmental Disability. Study 2: Stephens, Allen, Cheek & Fordyce (in preparation)

“At the start I was probably very unsure in the way you know how to handle our [child], and I think just some guidance along the way has helped me realise that I'm very capable of doing it, and some strategies probably in place that's helped me and I think well yes it's hard but we can get through it.” [P4, M] “It's given us strategies to assist with preparing [our child] for social situations that were previously difficult for us to attend, because of his sensitivities and inability to communicate now, we are prepared with strategies so we can go and function more in society.” [P5, F] ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

What we don’t know Why does one centre ‘work’ as a spoke, while another may not? Can we predict whether an ECEC service will successfully adapt to hub/spokes model? What are the main barriers or enablers? What is the parent experience of a spoke? Given resources are limited – should we be investing time, energy and cost in a centre that may not be ready? How can the hub best support the satellite/s (from an organisational and staff perspective)? Is this model cost effective? It’s working in NW Tasmania – will it work elsewhere? ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

Aims of the project To explore the operational and organisational support needs for staff delivering ASD early intervention in a mainstream ECEC under a hub and spokes model To determine how best to assess the readiness of a mainstream ECEC to provide ASD early intervention ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

Research Questions What are the key criteria that establish the readiness of a mainstream ECEC to provide ASD early intervention within a hub and spokes service delivery model? What are the barriers and enablers to providing effective ASD early intervention in a mainstream ECEC? Is there a difference in the barriers and enablers between regional and remote centres? How does the design of the built environment influence the capacity to provide effective ASD early intervention in mainstream ECECs? ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

Research Questions (cont). What are the experiences of staff providing ASD early intervention in autism specific and mainstream ECECs? What are the support needs of staff providing ASD early intervention in mainstream ECECs, and do these support needs differ based on the geographical isolation of the centres? Does the support and professional development provided by the ASELCC hub provide mainstream ECEC staff with management strategies that can be implemented more broadly to all children attending a mainstream ECEC? ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

Methods Mixed method approach based on realist evaluation (two phases): Photo-interview study with staff providing ASD early intervention in all ECECs in the NW Tasmania ASELCC hub and spokes model Development, piloting and validating of a tool to measure the readiness of a mainstream ECEC to provide early intervention to a child/children with ASD ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

Phase 1: Photo Interviews & Parent Questionnaires Three staff per mainstream ECEC (n=7 centres) + four staff from the ASELCC hub (n=25) + approximately 10 parents Methods: Staff take photos highlighting everyday practices within context of physical and spatial environment, make notes in journal. Follow-up interview based on photographs & journal Informal interviews with senior staff at each centre to discuss practicalities of delivering EI within this service delivery model (organisational context) Questionnaires for parents exploring experience of intervention via satellite program. Analysis: Framework analysis of photo interviews; Thematic analysis of parent questionnaire data ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

Phase 2: Readiness Tool Piloting & Validation A robust and rigorous approach to the refinement of the tool. It is anticipated that the tool will perform three functions: assess the readiness of a mainstream ECEC to deliver early intervention to children with ASD, and provide a strategic framework for a hub to work with prospective satellite centres to progress their level of readiness provide a formalised approach for the ongoing assessment of mainstream ECEC development and growth as a result of the support provided through a specialised hub. It is anticipated that there will be number of domains that focus on culture and processes, including resources and capacity, staff capacity and capability, and the design of the built environment. ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

Phase 2: Readiness Tool Piloting & Validation Methods: Initial scoping and mapping work was undertaken in late 2015; a formal review of existing tools/data including data from ECEC documentation (e.g. Quality Improvement Plans, Assessment and Rating Reports) and compared with other assessments of quality (e.g. ECERS, STEW); further development of the tool including a Delphi process to establish content and face validity; assessment of interrater reliability (Tasmanian ECECs); further revision and refinement of the tool; piloting and validation of the tool in centres in regional/remote/very remote (Category 3-7) settings in Tasmania, Western Australia (WA), Queensland (Qld) and New South Wales (NSW). Analysis:  Thank goodness for academics  ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

Key Deliverables Robust criteria & guidelines for assessing mainstream ECEC readiness for embedding an ASD early intervention service Report for DSS & NDIA summarising key findings and providing guidelines around staff support needs (and ways to meet these support needs) when implementing an ASD early intervention hub and spokes service delivery model in regional and remote settings ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

Follow the ASELCC on Facebook - http://on.fb.me/1Yvbmt1 All children and families from ASELCC ASELCC Staff Satellite Centres University of Tasmania Department of Social Services Local NW Tasmania Community Kathryn Fordyce Phone: 0427 739 397 Email: kfordyce@burnie.net or kathrynfordyce@stgiles.org.au Follow the ASELCC on Facebook - http://on.fb.me/1Yvbmt1 ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …